吸烟行为改变与缺血性脑卒中预后的关系：SPS3 试验的事后分析。
Change in Smoking Behavior and Outcome After Ischemic Stroke: Post-Hoc Analysis of the SPS3 Trial.
机构信息
Department of Neurosurgery (M.A., A.M.S.), Medical University of South Carolina.
Department of Neurology (T.N.T.), Medical University of South Carolina.
出版信息
Stroke. 2023 Apr;54(4):921-927. doi: 10.1161/STROKEAHA.121.038202. Epub 2023 Mar 6.
BACKGROUND
Cigarette smoking is a known risk factor for cardiovascular disease, including ischemic stroke. The literature regarding the rate of persistent smoking after acute ischemic stroke and its effect on subsequent cardiovascular events is scarce. With this study, we aimed to report the rate of persistent smoking after ischemic stroke and the association between smoking status and major cardiovascular outcomes.
METHODS
This is a post-hoc analysis of the SPS3 trial (Secondary Prevention of Small Subcortical Strokes). Patients were divided into 4 groups based on smoking status at trial enrollment: (1) never smokers, (2) former smokers, (3) smokers who quit at 3 months, and (4) persistent smokers. The primary outcome is a major adverse cardiovascular events composite of stroke (ischemic and hemorrhagic), myocardial infarction, and mortality. Outcomes were adjudicated after month 3 of enrollment until an outcome event or the end of study follow-up.
RESULTS
A total of 2874 patients were included in the study. Of the total cohort, 570 patients (20%) were smokers at enrollment, of whom 408 (71.5%) patients continued to smoke and 162 (28.4%) quit smoking by 3 months. The major adverse cardiovascular events outcome occurred in 18.4%, 12.4%, 16.2%, and 14.4%, respectively, in persistent smokers, smokers who quit, prior smokers, and never smokers. In a model adjusted for age, sex, race, ethnicity, education, employment status, history of hypertension, diabetes, hyperlipidemia, myocardial infarction, and intensive blood pressure randomization arm, the risk of major adverse cardiovascular events, and death were higher in the persistent smokers compared with never smokers (HR for major adverse cardiovascular events: 1.56 [95% CI, 1.16-2.09]; HR for death: 2.0 [95% CI, 2.18-3.12]). The risk of stroke, and MI did not differ according to smoking status Conclusions: Compared with never smoking, persistent smoking after acute ischemic stroke was associated with an increased risk of cardiovascular events and death.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT00059306.
背景
吸烟是心血管疾病（包括缺血性中风）的已知危险因素。关于急性缺血性中风后持续吸烟的发生率及其对随后心血管事件的影响的文献很少。本研究旨在报告缺血性中风后持续吸烟的发生率以及吸烟状况与主要心血管结局之间的关系。
方法
这是 SPS3 试验（小皮质下中风的二级预防）的事后分析。根据试验入组时的吸烟状况，患者分为 4 组：（1）从不吸烟者，（2）曾经吸烟者，（3）在 3 个月时戒烟者，（4）持续吸烟者。主要结局是中风（缺血性和出血性）、心肌梗死和死亡的主要不良心血管事件复合结局。在入组后 3 个月内对结果进行裁定，直至发生结果事件或研究随访结束。
结果
共纳入 2874 例患者。在总队列中，570 例（20%）患者入组时吸烟，其中 408 例（71.5%）患者持续吸烟，162 例（28.4%）患者在 3 个月时戒烟。持续吸烟者、戒烟者、曾经吸烟者和从不吸烟者的主要不良心血管事件发生率分别为 18.4%、12.4%、16.2%和 14.4%。在调整年龄、性别、种族、民族、教育程度、就业状况、高血压史、糖尿病、高脂血症、心肌梗死和强化血压随机分组臂后，与从不吸烟者相比，持续吸烟者的主要不良心血管事件和死亡风险更高（主要不良心血管事件的 HR：1.56[95%CI，1.16-2.09]；死亡的 HR：2.0[95%CI，2.18-3.12]）。中风和 MI 的风险与吸烟状况无关。
结论
与从不吸烟相比，急性缺血性中风后持续吸烟与心血管事件和死亡风险增加相关。
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